Implementation of an Internet & Paper-Based Uniform Data Set for OMH-funded Activities

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0990-0275 can be found here:

Documents and Forms

Document Name Document Type
0990-0275Appendix A.doc Other-Appendix A

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Implementation of an Internet & Paper-Based Uniform Data Set for OMH-funded Activities	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Appendix A			0990-0275Appendix A.doc		No	No	Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 150	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	300	300
Annual IC Time Burden (Hours)	1,350	1,350
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.